Dental Anxiety and Associated Demographic and Dental Attendance Factors: A Cross-Sectional Study Using the Modified Dental Anxiety Scale

Background: Dental anxiety is a common barrier to dental care and may influence treatment-seeking behavior and regular attendance. This study aimed to evaluate dental anxiety using the Modified Dental Anxiety Scale (MDAS), examine its distribution across demographic and dental-care characteristics, and identify factors independently associated with high dental anxiety. Methods: This cross-sectional study included 1005 participants aged ≥ 16 years attending dental clinics. Dental anxiety was assessed using the five-item MDAS, with scores ≥19 indicating high dental anxiety. Group differences in MDAS scores were evaluated using non-parametric tests, and internal consistency was assessed using Cronbach’s alpha. Associations with high dental anxiety were examined using categorical analyses and multivariable Firth-penalized logistic regression. Results: The median MDAS score was 11 (IQR, 7–15), and 49 participants (4.9%) had high dental anxiety. MDAS scores differed significantly according to gender, age group, education level, dental attendance frequency, reason for dental visit, and history of post-treatment complications (all p < 0.05). Anxiety differed significantly across the five MDAS items (Friedman χ2(4) = 624.477, p < 0.001), with anticipation of a dental visit producing the highest mean item score. The MDAS demonstrated good internal consistency (Cronbach’s α = 0.812). In multivariable Firth regression, gender, age group, dental attendance frequency, and primary reason for dental visit showed significant overall associations with high dental anxiety, whereas education level was not significantly associated after adjustment. Regular dental attendance was associated with lower odds of high dental anxiety. However, several category-specific estimates were highly imprecise because of sparse and clustered high-anxiety events, and sensitivity analysis indicated that some effect magnitudes were sensitive to model specification. Conclusions: Dental anxiety was generally low to moderate in this clinical sample, although a small subgroup met the threshold for high dental anxiety. Gender, age, dental attendance patterns, and reason for dental visit were associated with high dental anxiety. Regular dental attendance was associated with lower odds of high dental anxiety; however, the cross-sectional design precludes inference regarding the direction of this relationship. Brief anxiety screening and individualized communication may help identify and support patients with greater dental anxiety.